Every veterinarian has her day in court
Portia Stewart, Editor, Team Channel Director
Portia Stewart is a pun-loving editor who spends her days arguing the differences between cats and commas (commas are a pause at the end of a clause, while cats have the claws at the end of the paws). She is a minion to two cats and a dog.
When animals are victims of abuse, you may be called on to be their voice to speak to their emotionalas well as physicalsuffering.
Editor's note: This article contains graphic descriptions of animal suffering for the purpose of educating veterinary professionals on how to identify, report and prevent animal cruelty. Reader discretion is advised.
The pictures are haunting. A 3- to 4-month-old male pit bull, shot six times, hung from the fence outside an abandoned house by his black vinyl collar, his intestines spilling like a waterfall from his abdomen. The burned carcass of a spaniel trapped in her kennel when her owner attempted suicide by consuming sleeping pills and setting fire to the house-twice. The owner survived. The dog did not.
From a legal standpoint a key component of any animal abuse case is to match up the state's law on animal cruelty to the abused animal's experience. And this means law enforcement may look to veterinarians to testify for these animals.
Melinda Merck, DVM, who owns Veterinary Forensics Consulting in Austin, Texas, is working to educate veterinarians to prepare them to speak for voiceless pets. Merck spoke about how veterinarians can assess suffering in animal cruelty cases at the International Veterinary Emergency and Critical Care Symposium (IVECCS) in Grapevine, Texas. Consider these takeaways about veterinarians' ever-increasing role in this challenging area of medicine.
The five freedoms of animals
(Based on the Farm Animal Welfare Council Guidelines developed for cattle in the United Kingdom in 1979)
1. Freedom from hunger and thirst by ready access to fresh water and diet to maintain health and vigor.
2. Freedom from discomfort by providing an appropriate environment, including shelter and a comfortable resting area.
3. Freedom from pain, injury or disease by prevention or rapid diagnosis and treatment.
4. Freedom to express normal behavior by providing sufficient space, proper facilities and company of the animal's own kind.
5. Freedom from fear and distress by ensuring conditions and treatment that avoid mental suffering.
Failure to provide for any of these leads to suffering.
The state of words
Depending on where you live, your state's animal cruelty laws may address both pain and suffering in pets, and Merck says this is important, because it means the law is now recognizing other ways animals can suffer besides physical pain. Whether it's short-term, chronic or intermittent, you need to consider emotional suffering in every case.
“Veterinarians can have difficulty in this area,” Merck says. “Veterinarians are what I call golden retriever witnesses. We're used to people liking us, so we're not used to the adversarial courtroom experience.”
But, she says, there are a number of tools you can use to prepare to speak to the pet's suffering, including the five freedoms of animals, pain models and assessments and the 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. As a veterinarian with regular experience and contact with pets daily, you are poised to be an expert in pets' welfare. After all, in every veterinary visit you're making an assessment on your ability to treat, mitigate and alleviate suffering.
"Veterinarians are what I call golden retriever witnesses. We're used to people liking us, so we're not used to the adversarial courtroom experience," Merck says. We know pets experience emotional suffering, and it's been a driver for the enrichment and Fear Free movements, Merck says. For example, research has proven the human sadness system and the guinea pig separation distress circuit in the brain are similar.
Merck points to Franklin D. McMillan's book "Mental Health and Well-being in Animals" (Wiley-Blackwell, 2005) for more clues to pets' mental states, including boredom, distress and emotional maltreatment. A critical factor in each case, Merck says, is to consider the species, sex, breed and age to determine the pet's needs. She offered this breakdown:
• Boredom has both physical and psychological impacts, and it's the most evident.
• Distress is how an animal copes with an unpleasant affect. The causes may include boredom, pain, thirst, hunger, loneliness or fear manifestations.
• Emotional maltreatment: It's important to note the link between emotional states and physical health. Adverse emotion can cause distress, anguish and suffering. It can cause long-term problems, including separation anxiety, depression and more.
Merck also advises practitioners to look to the work of Rebecca Ledger, a British Columbia-based animal behaviorist. "Suffering can be inferred using behavioral and physical measures," Merck says. "It's important to watch for negative emotional states or the absence of positive states."
Using diagrams can be effective help visualize complicated descriptions, such as the trajectory of bullets.
Quick forensic tips
If you're called on to be part of an investigation, Dr. Melinda Merck of Veterinary Forensics Consulting in Austin, Texas, offers these tips:
• Avoid bias.
• Consider the information you're presented with by investigators, and ask questions.
• Consider alternate theories. Don't ignore facts that don't fit. These could be key to another area of investigation.
• Consult with your colleagues.
• Learn the language so you can speak it. Some terms you should know:
- reasonable degree of certainty
- consistent with
And remember to stay within the bounds of your expertise. Merck says it's usually when veterinarians go out on a limb that the opposing counsel will try to impeach their credibility.
• Try to recreate the sequence of crime scene events.
• Try to determine the degree of hemorrhage or bruising and whether it occurred antemortem, perimortem or postmortem.
• Start with the fatal injuries and backtrack.
• Use diagrams for injuries, especially skull fractures. (Remember, you're shooting for layman's terms in your summary of findings that should be understandable for someone with a fifth-grade reading ability.)
• Consider the effect of each injury. Would it affect the animal's ability to move, vocalize or resist?
How do you assess emotion?
So clearly pets can't tell you how they feel, and most behaviorists will shy away from ever telling you exactly what a dog or cat is feeling-it is unknowable without the ability to communicate at a higher level or use some sort of Star Trekkie Vulcan mind meld not yet invented by modern technology.
But hark! Technology can help. Consider this: Merck advises using video to capture and evaluate signs of the pet's emotions, including the animal's behavioral expression and the physical evidence. Ask yourself this: Do you note negative emotional states or the absence of positive states?
For behaviors, Merck points to watching for overt expressions, vocalization, locomotion, posture and the lack of self-maintenance. She also watches for signs of anxiety; a vigilant phase; apprehensiveness or worry caused by unfamiliar surroundings, people, animals, handling, noises or smells; and a paw-lift. When pets are worried, there's a correlative increase in cortisol concentrations. Also watch for these signs:
• avoiding eye contact
• ears back, mouth slightly open
• dilated eyes
• barking or agitation
• separation anxiety
• excessive paw-licking.
Merck also identified the following signs of a pet's mental state and some of the situations that might cause them. Pets may suffer from frustration when they can't perform the activities they need to-for example, they're denied social interaction, can't get to the source of their aggravation or can't reach something they need to get to, such as a female dog needing to reach her babies.
Pets may also experience depression, Merck says. This is a phase of learned helplessness and it takes a long time-many months of neglect, such as prolonged kenneling, isolation, barren environment and repeated abuse. To identify this state, you need to watch for absence of a positive affective state-for example, the pet is not interested in play, the dog doesn't chew on sticks, eat, retrieve or seek to be petted, Merck says. Remember, you need to look to both what's causing the pet's state and what's lacking.
Veterinarians may be called on to be the voice for animals in court.
What would you do?
How should you handle cases of abuse, neglect and inappropriate requests for euthanasia? It's a question Lisa Moses, VMD, DACVIM (SAIM), CVMA, of Angell Animal Medical Center in Boston, Massachusetts, posed in a presentation at the International Veterinary Emergency and Critical Care Symposium (IVECCS) in Grapevine, Texas.
"A lot of what makes veterinary medicine challenging is prioritizing our roles to serve the law, the patient, the client and our own conscience," Moses says. "These interests can compete and cause discomfort."
She advocates for ethical reasoning because she says it helps give a voice to the voiceless, to provide a framework for resolution and it accounts for your own personal intuition. She offered up this approach for clinicians to evaluate ethical issues:
1. State the problem clearly.
2. Gather data.
3. Identify the nonmedical factors (think: values).
4. Decide whether more information or dialogue is needed.
5. Identify feasible resolutions and options.
6. Test possible resolutions and support with references to your chosen framework.
7. Decide and act.
She also urged attendees to consider the principles in biomedical ethics: respect for autonomy (this applies to your autonomy and possibly the pet's as well), beneficence, nonmaleficence and justice.
Finally, she boiled it down to these questions you can ask when you evaluate your ethical situation:
• Which act is right?
• What would the most virtuous person you know do?
• Which policy is fair?
• Who gets to decide?
So what is the veterinarian's responsibility when it comes to abuse? Moses says at least 11 states mandate veterinarians report animal abuse. And most states encourage reporting and provide legal immunity. But, she says, North America is largely a patchwork of regulations and enforcement agencies for abuse. So this leaves the question: What is the veterinarian's ethical responsibility? Consider these facts:
• Animal abuse is a major tip-off that people in the household are in danger. ASPCA research has shown that in houses where domestic violence occurs, the incidence of animal abuse is almost 90 percent.
• Abusers often target animals to hurt people.
• Children who live in violent homes become the perpetrators in almost one-fifth of animal abuse cases while they're still minors. (Read more about the connection between animal cruelty and human violence here.)
So how can you recognize non-accidental injuries in animals? Moses offered these signs as a starting point:
• An inconsistency between the patient's history and physical exam
• A different pattern of injuries in non-accidental injuries-for example, more cranial or on both sides of the body
• Signs of past injury
• Animal abusers often volunteer an explanation of how the pet was injured.
See "Characterization and Comparison of Injuries Caused by Accidental and Non-accidental Blunt Force Trauma in Dogs and Cats" in the Journal of Forensic Sciences to learn more.
Putting these ideas into practice: The gothic kitten case
It's a chilling tale that seems more fit for an episode of Law and Order than real life. In 2010, a groomer used 14-gauge barbell earrings to pierce black kittens' ears and the backs of the necks and used a rubber band to dock some of their tails. She tried to sell them as "gothic kittens" for $100 on eBay, and that's when law enforcement got involved. The question Merck posed: How could they use the animal cruelty statute to make a case the kittens had been tortured?
The first struggle, Merck said, was to identify what constituted torture. This sounds simple, right? You know it when you see it? But it really takes a little bit more. Remember, this was going to court. The guideline Merck agreed on: the kittens were subjected to something they couldn't control or escape from.
An obvious objection: sheep's-and cattle's-tails are banded, so how is banding kittens' tails torture? The response: This isn't an accepted practice in kittens, Merck says, and we can't apply the large-animal standard to kittens.
Some of the things Merck pointed to in her consultation with law enforcement leading up to the trial to show signs of the pets' distress:
• Infection was present at the piercing sites.
• Piercing the kittens' ears could decrease their ability to hear.
• The back of the neck is a highly sensitive area for kittens.
• Kittens' ears and tails are used as a form of communication, and the piercings and docking effected their ability to communicate.
• The kittens displayed abnormal behavior after the piercing and tail docking attempt, including sitting-not running-which speaks to fear, pain and physical and emotional distress.
• The kittens could not escape or affect change on their environment and experienced fear or pain.
The groomer was sentenced to six months' house arrest and charged with a felony. She also received 21 months' probation and was required to have no physical contact with pets for 21 months.
When you open your awareness to emotional suffering, Merck also advises you to consider large-scale cases of neglect, such as hoarding, puppy mills and domestic violence cases.
If you're uncomfortable with the state of the laws in your state, Merck recommends contacting your state legislature. She said she's found legislators will become responsive when they hear a message from eight or more people, and they begin to think the concern applies to a broader swath of their constituents.
For veterinarians who are wary of being the voice for pets, Merck encourages them to have more confidence in their training and in their ability to learn to advocate for animals. "Because animals can't speak, veterinarians can speak for them with observation and documentation," Merck says.